Health Insurance Jargon Spurs Widespread Confusion

With a language all its own and processes that mystify even veterans of its industry, health insurance is a problem among consumers of all ages.

“People are treating it more like care insurance: you don’t use it until something happens” Kathleen Call, a professor in the University of Minnesota’s School of Public Health, said to Kaiser Health News.

“You have an accident, then you use it. Otherwise you’re trying not to use it. And that’s not the way we want health insurance to be used.”

Related Post: ClaimLinx Glossary: Common Health Insurance Terms

Make sure you understand how your insurance plan works so you feel confident when using it.

To assist with this, here are five of the most commonly searched words in the healthcare industry along with their definitions.

  1. Deductible – The amount a person owes for healthcare services before future covered benefits are paid. Note, copays and other out of pocket expenses are often not applied toward a deductible.
  2. Copay or Copayment – The fixed amount you pay for a covered healthcare service, typically paid on the date of the service.
  3. Coinsurance – Your share of the costs of a covered healthcare service, calculated as a percent of the allowed, or discounted, amount for the service.
  4. Coverage determination – The decision made by your primary insurance carrier whether a service is covered. Note, your secondary coverage will follow your primary plan’s determinations.
  5. Explanation of Benefits – A statement, either from your primary insurance carrier or from ClaimLinx, with details about what your plan covers, how much was paid, how much money, if any, is still owed and more.

Related Post: How Coordination of Benefits Saves Money for Your Employees

Look for more details on health insurance jargon in the future or contact with any specific questions.

Higher Deductibles Shift Health Costs to Employees

In recent years, the rise in healthcare premium costs has slowed significantly. But many consumers have not felt the change, as expenses have shifted to plan members.

Staying on trend with recent years, premiums for job-based medical insurance rose by just 4 percent in 2015, with the average single coverage plan costing $6,251 and the average family plan costing $17,545.

But deductibles, the amount plan members contribute for care before the insurance company pays the bulk of a bill, have continued to rise, much faster than total healthcare costs.

Related Post: What are copays, deductibles and coinsurance?

The Kaiser Family Foundation and the Health Research and Education Trust surveyed nearly 2,000 large and small employers on insurance premiums, employee contributions, deductible costs and average member salaries.

The recently published findings show the burden of overall healthcare costs shifting to members through rising deductibles. It’s an especially concerning trend, as the wages have not risen at the same rate in recent years.

“The so-called great slowdown in healthcare costs has been all but invisible to consumers because deductibles have been going up so much faster than their wages,” Drew Altman, CEO of the Kaiser Family Foundation said.

According to the survey, 46 percent of workers receiving coverage through their workplace have a deductible of at least $1,000 this year. Almost 20 percent of workers have deductibles more than $2,000.

The average dollar amount for deductibles for individual plans has risen by more than 65 percent since 2010 while premiums have risen by only 25 percent. Meanwhile, worker wages have risen by only about 10 percent.

Whether this trend will continue in the future remains contested among analysts. Healthcare costs have grown faster than the rest of the economy for decades, pressing on the pockets of workers and employers alike, but they slowed significantly after the 2008 financial crisis.

Related Post: ClaimLinx solves spiking insurance premium problem

Experts predict employer-sponsored insurance premiums will rise as the economy improves, but they are not expected to reach the 11 percent average annual growth seen from 1999 to 2005.

Ultimately, it will become increasingly important to be mindful of overall healthcare cost sharing among employers, employees and the insurance company in the future.

New Website Helps Compare Prices on Health Care Procedures

There’s a lot of mystery that comes with the bill you receive after a medical procedure. Unlike other services, in which you receive a breakdown in cost of labor, materials and other expenditures, a medical bill can often seem like an arbitrary, or even random, amount.

But one new website is working to change that.

Related Post: Employers Considering Alternatives to Rising Health Care Costs, the site launched Feb. 25, “puts actual cost information in consumer’s hands” to help them become savvier shoppers. It combines information from United Healthcare, Humana, Aetna and Assurant Health on what they actually pay for dozens of medical services.

The site is funded by the Health Care Cost Institute, a nonprofit organization focused on providing clear, factual insight into health care costs so that consumers, researchers and policymakers can understand and manage costs while still keeping a high standard of care.

“The rise in health care spending underscores the need to make it more transparent and help consumers make more informed decisions regarding their care,” David Newman, executive director of HCCI, said to the Washington Post.

Currently, the site compares the costs of more than 70 common medical services, which range from a simple doctor’s visit to a complex spinal surgery. It primarily focuses on procedures that patients have the ability to shop for ahead of time, not necessarily those that come along with emergency care.

Related Post: Health Insurance Jargon Spurs Widespread Confusion

It’s a first step in demystifying medical billing in this country, as research has shown prices for the same medical service can vary drastically, even within the same city. For example in Dallas, a knee surgery can cost $16,772 at one hospital or $61,585 at another. also breaks down each procedure’s process and recommends questions for consumers to ask their doctors. It’s a helpful resource for anyone with a doctor’s appointment on the horizon.